Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Sleep Breath. 2021 Dec;25(4):1843-1850. doi: 10.1007/s11325-021-02288-1. Epub 2021 Jan 19.
Volume-assured pressure support in noninvasive ventilation (VAPS-NIV) is a newer mode providing automatic pressure support adjustment to ensure a constant alveolar ventilation. Previous studies have shown that NIV effectiveness depends on patient adherence and tolerance. The aim of this study was to determine the adherence and efficacy of VAPS-NIV compared to spontaneous-time (S/T) mode in pediatric patients with neuromuscular disease (NMD).
This was a prospective observational study. Children with NMD who utilized NIV at home for ≥ 3 months were recruited from the Long-term ventilation clinic at The Hospital for Sick Children, Toronto, Canada, from July 1, 2015, to July 1, 2019. Baseline characteristics, date of initiation of NIV, and pulmonary function tests were recorded. Polysomnogram (PSG) data and adherence were recorded and analyzed comparing VAPS and S/T modes.
Twenty children with NMD (17 male, 85%) were enrolled. The mean (SD) age at initiation of NIV was 11.6 ± 4.6 years. The median (IQR) duration of ventilation was 1.36 (0.80-2.98) years. The mean average daily usage and the median daily usage for VAPS mode and S/T mode were 8.4 ± 1.6 versus 7.2 ± 2.5 h (p = 0.012) and 8.6 ± 1.4 versus 7.8 ± 2.1 h (p = 0.022), respectively. There was no difference in sleep architecture, gas exchange, or parent proxy report of NIV tolerance between S/T and VAPS modes.
VAPS was associated with an improvement in adherence to therapy in children with NMD compared to S/T mode. Longitudinal studies are required to evaluate long-term clinical outcomes using VAPS mode in children with NMD.
无创通气中的容量保证压力支持（VAPS-NIV）是一种较新的模式，它通过自动调整压力支持来确保恒定的肺泡通气。先前的研究表明，NIV 的效果取决于患者的依从性和耐受性。本研究旨在比较 VAPS-NIV 与自主时间（S/T）模式在神经肌肉疾病（NMD）患儿中的依从性和疗效。
这是一项前瞻性观察性研究。2015 年 7 月 1 日至 2019 年 7 月 1 日，从加拿大多伦多 SickKids 医院的长期通气诊所招募了在家中使用 NIV 治疗≥3 个月的 NMD 患儿。记录了基线特征、NIV 开始日期和肺功能检查。记录并分析了多导睡眠图（PSG）数据和依从性，比较了 VAPS 和 S/T 模式。
共有 20 名 NMD 患儿（17 名男性，85%）入组。NIV 起始时的平均（SD）年龄为 11.6±4.6 岁。中位（IQR）通气时间为 1.36（0.80-2.98）年。VAPS 模式和 S/T 模式的平均每日使用时间和中位每日使用时间分别为 8.4±1.6 小时与 7.2±2.5 小时（p=0.012）和 8.6±1.4 小时与 7.8±2.1 小时（p=0.022）。S/T 模式和 VAPS 模式的睡眠结构、气体交换或家长对 NIV 耐受性的代理报告无差异。
与 S/T 模式相比，VAPS 可提高 NMD 患儿对治疗的依从性。需要进行纵向研究，以评估 VAPS 模式在 NMD 患儿中的长期临床结局。
